[EQ] Caring for people with chronic conditions

Caring for people with chronic conditions

A health system perspective

 

Published by Open University Press

European Observatory on Health Systems and Policies series, WHO 2008

 

Available online PDF [290p.] at: http://www.euro.who.int/Document/E91878.pdf

 

“…..New recognition of the multiplicity of influences on health, the variability in vulnerability and resilience of different individuals and population groups to threats to illness, and the emerging crisis of harm from iatrogenic causes is calling into question the adequacy of health systems to deal in conventional ways with illness burdens of people and populations. It may even call into question the adequacy of conventional ways of classifying illness. The current focus on chronic care management is one approach to dealing with this rapidly changing challenge of describing and understanding ‘disease’ in the 21st century. Whether it is the appropriate one remains to be seen.

A disease oriented approach to global health will almost certainly worsen global inequities, because socially disadvantaged people have greater burdens of diseases of all types. Eliminating or controlling diseases one by one is not likely to materially reduce the chances of another in vulnerable populations. It may also be unconscionable when the most serious shortfalls in achieving the Millennium Development Goals are in maternal and child health. Good primary care, which focuses on ALL health conditions with a comprehensive array of services, may be a much better approach to achieve equity in health as well as overall improvement in health.

In this excellent summary of challenges and approaches to dealing with chronic disease in Europe, the editors have done yeoman’s work in setting the stage for widespread deliberation of the issues in diseased-focused care. Some chapters frankly advocate (without evidence) for a focus on ‘chronic disease’ rather than on person-focused care with responsiveness to person-defined needs and priorities. But the introductory chapter and summary, as well as many of the other chapters provide a balanced view; the review indicates a lack of evidence of benefit of a focus on specific chronic diseases. We are still a long way away from knowledge, wisdom and political will to achieve effective, equitable, and efficient health services systems that improve the health of populations and subpopulations. …”  [Professor Barbara Starfield MD, MPH John Hopkins Bloomberg School of Public Health]

 

Content

 

one Caring for people with chronic conditions: an introduction

Ellen Nolte and Martin McKee

 

two The burden of chronic disease in Europe

Joceline Pomerleau, Cécile Knai and Ellen Nolte

 

three Economic aspects of chronic disease and chronic disease management

Marc Suhrcke, Daragh K. Fahey and Martin McKee

 

four Integration and chronic care: a review

Ellen Nolte and Martin McKee

 

five Preventing chronic disease: everybody’s business

Thomas E. Novotny

 

six Supporting self-management

Mieke Rijken, Martyn Jones, Monique Heijmans and Anna Dixon

 

seven The human resource challenge in chronic care

Carl-Ardy Dubois, Debbie Singh and Izzat Jiwani

 

eight Decision support

Nicholas Glasgow, Isabelle Durand-Zaleski, Elisabeth Chan and Dhigna Rubiano

 

nine Paying for chronic disease care

Reinhard Busse and Nicholas Mays

 

ten Making it happen

Ellen Nolte and Martin McKee

 

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